The first clinical application of a ?hands-on? robotic knee surgery system

Abstract

The performance of a novel "hands-on" robotic system for total knee replacement (TKR) surgery is evaluated. An integrated robotic system for accurately machining the bone surfaces in TKR surgery is described. Details of the system, comprising an "active constraint" robot, called Acrobot, a "gross positioning" robot, and patient clamps, are provided. The intraoperative protocol and the preoperative, CT-based, planning system are also described. A number of anatomical registration and cutting trials, using plastic bones, are described, followed by results from two preliminary clinical trials, which demonstrate the accuracy achieved in the anatomical registration. Finally, the first clinical trial is described, in which the results of the anatomical registration and bone cutting are seen to be of high quality. The Acrobot system has been successfully used to accurately register and cut the knee bones in TKR surgery. This demonstrates the great potential of a "hands-on" robot for improving accuracy and increasing safety in surgery.

Computer-assisted orthopedic surgery

“…Another system constrains the range of movement of a surgical tool held by a robot arm such as ACROBOT. 20 The tool can be moved freely in space by the surgeon's hand within the preprogrammed range; it is never moved by the robot. The last system is an active one, such as ROBODOC 4 or CASPAR, 39 which moves a milling device automatically according to preoperative planning.…”

Robots in the operating theatre—chances and challenges

“…The Acrobot system is not based on an industrial robot but is a specially designed surgical robot 46 . This so-called ''hands-on'' robot system keeps the surgeon in the control loop of the cutting procedure and is used for total knee replacement (TKR).…”

Robotic clinical trials of uni-condylar arthroplasty

“…Work on the AcrobotH system for orthopaedic surgery started in late 1991 in collaboration with Mr Justin Cobb, and was first clinically implemented for TKR in 2000 with considerable success (3,13) . The work benefited from early robotic experiences, such as the need for a pre-operative image-based planning phase and for systems to intra-operatively register the robot to the plan.…”